Enteral tube feeding for older people with advanced dementia

Sampson, Elizabeth L; Candy, Bridget; Jones, Louise

doi:10.1002/14651858.cd007209.pub2

Cited by 317 publications

(262 citation statements)

References 37 publications

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“…Para pacientes com idade e demência avançada, a introdução e a continuidade da TNE por sonda ou gastrostomia, apesar de ser apropriada em alguns casos, priva o indivíduo da sensação de paladar, favorecendo a diminuição de sua dignidade e autoestima. Em geral, essa situação proporciona maior agitação, desconforto e necessidade de sedação nesses pacientes 5,18 .…”

Section: Terapia Nutricional Enteral Nos Cuidados Paliativos De Doençunclassified

Consensos e dissensos na indicação e continuidade da terapia nutricional enteral nos cuidados paliativos de pacientes com doenças crônicas não transmissíveis

2017

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RESUMOAs doenças crônicas não transmissíveis (DCNT) representam as principais causas de internações hospitalares, geram impactos socioeconômicos e comprometimento da qualidade de vida em virtude de suas sequelas e incapacidades, justificando a importância e necessidade crescente de associação dos cuidados paliativos ao tratamento curativo. Esta revisão narrativa visa apresentar os consensos e dissensos sobre a indicação e a continuidade da terapia nutricional enteral (TNE) nos cuidados paliativos de pacientes com DCNT. Embasou-se em publicações oficiais sobre o tema e 15 artigos divulgados nas bases de dados: LILACS, SciELO, PubMed, MEDLINE, Cochrane Library e Science Direct, entre os anos de 2005 e 2016. Os objetivos do suporte nutricional nos cuidados paliativos desses pacientes variam com a evolução da doença. O suplemento nutricional oral é indicado para complementar a ingestão alimentar oral insuficiente, reduzindo custos hospitalares e favorecendo melhoras clínicas e funcionais. Na ingestão alimentar menor do que 60% e sem previsão de evolução, é indicada a TNE dentro dos três primeiros dias, mas sua continuidade em doenças avançadas permanece controversa. Na fase terminal, prioriza-se o conforto, o alívio dos sintomas e não mais a adequação nutricional. Nessa fase, a nutrição e hidratação artificiais podem não ser benéficas. Dessa forma, a nutrição nos cuidados paliativos é individualizada, depende do estágio da doença e visa promover a qualidade de vida. As tomadas de decisão devem envolver a vontade do paciente e de seus familiares, considerando os princípios de autonomia, beneficência, não maleficência e justiça.Palavras-chave: cuidados paliativos; doença crônica; terapia nutricional. ABSTRACTNon-communicable diseases (NCD) are the leading cause of hospital admissions, result in socioeconomic impacts and prejudice on quality of life due to after-effects and disabilities, justifying the importance and the increasing need to associate palliative care with curative treatment. This narrative review aims to introduce agreements and disagreements on indication and continuity concerning enteral nutritional therapy (ENT) in palliative care patients with NCD. This paper was based on official publications related to the topic and 15 articles found on LILACS, SciELO, PubMed, MEDLINE, Cochrane Library and Science Direct databases, between the years 2005 and 2016. In these patients, the objective of nutritional support in palliative care varies according to the evolution of the disease. Oral nutritional supplement is indicated to supplement insufficient oral food intake, reducing hospital costs and favoring clinical and functional improvements. When food intake is less than 60% and without evolution prospects, ENT is indicated within the first 3 days, but withholding and withdrawing it in advanced diseases remains controversial. In terminal phase, comfort and relief of symptoms are the priority instead of nutritional adequacy. On this stage, artificial nutrition and hydration may not be beneficial. Therefore, nutri...

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Section: Terapia Nutricional Enteral Nos Cuidados Paliativos De Doençunclassified

Consensos e dissensos na indicação e continuidade da terapia nutricional enteral nos cuidados paliativos de pacientes com doenças crônicas não transmissíveis

2017

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“…For example, it is perfectly possible to compare the outcomes of artificial nutrition with not providing it, in terms of survival, pain, quality of life and so on (see Sampson et al [3] for a review). Although, note that either arm of this trial can be regarded as palliative care so, even if one arm does better, this doesn't tell us if palliative care is effective.…”

Section: Empiricalmentioning

confidence: 99%

Palliative care in dementia: Does it work?

Dening

2016

Maturitas

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“…There is no evidence that artificial feeding improves outcomes, and a recent Cochrane systematic review found insufficient evidence to suggest that enteral tube feeding is beneficial in patients with dementia. [51][52][53] Instead, dementia patients at the end of their lives benefit from a palliative approach, which would include hand-feeding for comfort if the patient indicates hunger. 54 …”

Section: Treating Nondementia Illnesses In Hospitalized Elders With Dmentioning

confidence: 99%

Ten ways to improve the care of elderly patients in the hospital

Labella

Merel

Phelan

2011

Journal of Hospital Medicine

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Hospitalists care for elderly patients daily, but few have specialized training in geriatric medicine. Elderly patients, and in particular the very old and the frail elderly, are at high risk of functional decline and iatrogenic complications during hospitalization. Other challenges in caring for this patient population include dosing medications safely, preventing delirium and accidental falls, and providing adequate pain control. Ways to improve the care of the hospitalized elderly patient include the following: screening for geriatric syndromes such as delirium, assessing functional status and maintaining mobility, and implementation of interventions that have been shown to prevent delirium, accidental falls, and acute functional decline in the hospital. This article addresses these issues with 10 evidence‐based pearls developed to help hospitalists provide optimal care for this expanding population. Journal of Hospital Medicine 2011;6:351–357. © 2011 Society of Hospital Medicine

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Enteral tube feeding for older people with advanced dementia

Abstract: Despite the very large number of patients receiving this intervention, there is insufficient evidence to suggest that enteral tube feeding is beneficial in patients with advanced dementia. Data are lacking on the adverse effects of this intervention.

Cited by 317 publications

References 37 publications

Consensos e dissensos na indicação e continuidade da terapia nutricional enteral nos cuidados paliativos de pacientes com doenças crônicas não transmissíveis

Consensos e dissensos na indicação e continuidade da terapia nutricional enteral nos cuidados paliativos de pacientes com doenças crônicas não transmissíveis

Palliative care in dementia: Does it work?

Ten ways to improve the care of elderly patients in the hospital

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